Update on COVID-19 Private Payer Guidance

May 20, 2020

To assist members in navigating private payer policies, IHA has created a table that summarizes COVID-19 coverage of testing/screening and treatment for health plans offered by health insurance issuers operating in Illinois. The COVID-19 treatment information generally applies to private fully-insured, individual, and group health plans. It does not address policies for self-funded group health plans (ERISA), Medicare Advantage plans, or Medicaid managed care plans.

Federal law requires most health insurance issuers offering individual and group health plans, including self-funded employer-based health plans (ERISA) to waive cost-sharing, prior authorization and other medical management policies, and network requirements for COVID-19-related testing and screening services; however, there are currently no federal or state mandates regarding treatment of COVID-19. Coverage flexibilities for treatment are generally at the discretion of the health insurance issuer based on plan type and benefit design and typically limited to in-network services.